Psychosis

Question 1

Define psychosis

Answer 1

a mental state in which reality is greatly distorted: presenting with delusions, hallucinations, passivity phenomenon and thought disorders

Question 2

Define delusions

Answer 2

a fixed false belief, which is firmly held despite evidence to the contrary and that goes against social norms and cultural beliefs

Question 3

Define hallucinations

Answer 3

a perception in the absence of an external stimulus

Question 4

Define thought disorders

Answer 4

impairment in ability to form thoughts from logical ideas

Question 5

What are the 5 modalities of hallucinations?

Answer 5

auditory - 1st and 2nd person
visual
olfactory
gustatory
somatic

Question 6

What are pseudohallucinations?

Answer 6

hearing voices inside your head as opposed to external voices heard as though they are real in actual*

Question 7

What are some differentials for hallucinations?

Answer 7

2nd person - mania
3rd person - schizo
auditory - temporal lobe epilepsy
olfactory - frontal lobe meningioma
visual - delirium

Question 8

What are some examples of delusions?

Answer 8

grandiose
persecutory
reference
guilt
hypochondriac
nihilistic

Question 9

What are some delusions classically seen in depression?

Answer 9

guilt
nihilism
hypochondriasis
poverty

Question 10

What is schizophrenia?

Answer 10

psychotic condition characterised by positive and negative symptoms which lead to functional impairment

Question 11

what are some risk factors in developing schizophrenia?

Answer 11

family hx
childhood abuse
substance misuse
migrants - afro-caribbean

Question 12

What are some positive sx of schizophrenia?

Answer 12

delusions
hallucinations
thought disorder
thought interference - thoughts not your own
passivity phenomena - actions, feelings and emotions controlled by external force
through broadcast - running commentary

Question 13

What are some negative sx of schizophrenia?

Answer 13

low motivation
asocial behaviour
anhedonia
decrease in speech
blunted affect
attention deficits

Question 14

How might you Ix for schizophrenia?

Answer 14

• blood tests to r/o infection, serum calcium, u&e, LFT, vit b12 and folate
• urine drug test and dip
• ECG
• CT head
• EEG

Question 15

How might you manage a patient with schizophrenia?

Answer 15

risk assessment and use of MHA
medication
CBT
psychoeducation involving families
Art therapy to help -ve in young
social skills training
support groups, peer support
supported employment programmes

Question 16

What is the role of medication in schizophrenia?

Answer 16

Atypicals like Risperidone and Olanzapine first line
Depot if non-compliant
Clozapine to tx-resistant
Benzo for short term behaviours
Antidepressants and lithium to augment antipsychotics
ECT? (catatonic)

Question 17

What is schizotypal disorder?

Answer 17

latent schizophrenia
eccentric behaviour, suspiciousness, unusual speech and deviations of thinking and affect similar to schizophrenia but WITHOUT delusions and hallucinations

Question 18

What is schizoaffective disorder?

Answer 18

both sx of schizo and a mood disorder (depression or mania) in same episode of illness

Question 19

What is puerperal psychosis?

Answer 19

acute onset of mania or psychotic episode shortly after childbirth, within first 2w affecting 0.2% of women